An 86 Year Old Woman presented with right MCA syndrome
An 86 year old woman with known history of atrial fibrillation on Coumadin (INR 2.2) presented to ER with acute onset left hemiplegia and right gaze preference (NIHSS 14). She was last seen normal approximately four hours ago. Her pre-hospitalization modified Rankin Scale was 0. CT ASPECT score on presentation was 9 without evidence of hemorrhage. CT Angiogram of head showed right M1 occlusion and critical stenosis of the right internal carotid artery at the carotid bifurcation. She was ruled out for intravenous thrombolysis due to therapeutic INR.